means of monitoring fluid status, but in patients with severe burns with associated inhalational injury, central venous pressure monitoring may be useful in the first few hours Major burns cause decreased splanchnic blood flow and ileus After ensuring intact airway reflexes or that the airway is protected by placement of an endotracheal tube, the clinician should consider placing a nasogastric tube Hypothermia can occur rapidly in small children, especially in those whose skin injury impairs normal thermoregulation Core temperature should be monitored and the child kept covered, except as necessary for examination and burn assessment Fluid Resuscitation An initial bolus of 20 mL/kg of normal saline or Ringer lactate solution is recommended while assessment of the extent of the burns takes place Fluid volume from all initial boluses including prehospital care should be counted when calculating fluid volumes during the first 24 hours of treatment A urinary catheter should be placed early in the management because there may be several hours of monitoring during transport or in the ED during which urine production can provide clinicians with information about fluid status Rapid treatment of the hypovolemia that occurs early in children with severe thermal injuries is of prime importance The fluid status of children with burn injury is a dynamic process that requires careful reevaluation and therapeutic adjustments Extravasation of water, sodium, and protein through abnormally permeable capillaries continues for about 24 hours after injury Capillary integrity then improves and intravascular volume stabilizes Isotonic crystalloid solutions are recommended in the resuscitation phase Potassium is released from damaged cells and measured serum levels may be elevated shortly after injury; therefore, potassium replacement is not recommended during the early phase of fluid therapy Several formulas for the calculation of initial fluid therapy exist ( Table 104.2 ) The Parkland formula recommends mL/kg/% of BSA of crystalloid over the first 24 hours, half during the first hours from the time of injury and half during the next 16 hours This formula often underestimates the fluid needs of young children, who are also at greater risk for hypoglycemia Maintenance requirements using isotonic solutions with 5% dextrose are added for patients with burns who are younger than